Medicare

What is my annual maximum limit for 2016?

2016 Annual limit is $1940, which is approximately fifteen visits of treatment. If you chose to come three times per week, this amount will be reached in six weeks; two times per week, this maximum limit will be reached in nine weeks.

Can my Medicare treatment be extended?

Therapy can be extended under certain circumstances only when medically necessary. Please speak with your physical therapist regarding extending your treatment. What is medically necessary treatment is a subject of wide debate and litigation. Here is a link regarding current Medicare policy.

What is Secondary and Supplemental Insurance?

Medicare will cover only 80% of the $1940 limit.

The additional 20% is covered by secondary or supplemental insurance ($384 out of $1940).

Medicare Supplemental Insurance, or Medigap, is a type of secondary insurance that fills in coverage gaps in the standard Medicare policy. The policy is offered by private companies. You can buy the insurance only if you already have Medicare Part A and Part B.

Medicare secondary insurance is group health insurance that comes through your employer, often as a retirement benefit. Medicare and Medicare secondary insurance benefits often overlap. The benefits paid by Medicare secondary insurance will be those not already covered by Medicare Parts A and B. You usually need to enroll in Medicare Part B before your secondary insurance company will pay benefits.

Medicare secondary insurance policies include AARP, Blue Cross/Blue Shield, Empire Plan, Vytra, GHI, Emblem, and Tricare. Depending on your policy you may be responsible for part or all of the payment.

With Medicare how do I get an appointment if I am injured?

Medicare claims for Physical Therapy require a physician’s prescription or referral. Medicare also wants a certified “Plan of Care”. If one is not included in your physician’s referral or prescription, your therapist will send one to your physician. Your physician must sign it in order to continue treatment.

How would my physician know my progress?

Your therapist will send progress reports to your physician once every ten treatments.